In my week with Director Chen, I have seen the clinical face to renal maladies we learned didactically. I have seen the realities patients must face when their chronic kidney disease progresses, and the lifestyle and diet choices they must come to terms with. The complicated UTI. The hydronephrosis. Polycystic kidney disease. The diabetic with associated nephropathy. Sometimes, it is hard to grasp how much is at stake with each individual. I run through wards and hear patients say familiar words and phrases: "my ankles are swollen"; "I have flank pain"; "it hurts when I urinate." Did they read the same textbook as me? Are they play-acting as standardized patients? Is all of medicine a play, and everyone has a different role?
I saw the practice of empirical and step-by-step medicine in diagnosis and treatment. Each lab value, culture result, physical exam finding, CXR, CT, or renal echo finding led to a more complete picture of the underlying etiology. Patients improve as fevers are systematically lowered and creatinine is normalized. Discharged, patients echo their gratitude as doctors quickly smile and nod and move on.
At the same time, it was inspiring to see Director Chen and other physicians offer tenderness in a culture of expected paternalism and a healthcare system of ruthless efficiency. The same courtesy was extended to us whenever he took the time to explain many of his cases or to ask us questions.
It seems that renal disease is a recurring theme in my own family; observing quality, patient-centered care was empowering to learn what could have been and can be done for my family and love ones. I could not have expected a better first week in a foreign hospital across the world.
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